NURS 621 Midterm Exam questions with
best solutions
Dx: Acute otitis media - answersH&P:
• Ear pain (typical)
• Decreased hearing (typical)
• Fever (sometimes)
• Recent URI or exacerbation of seasonal allergic rhinitis (can be)
• Unilateral (usual)
• Bulging tympanic membrane (needed to distinguish from otitis media with effusion).
Can also be erythematous or opacified. Tympanic membrane can rupture (feels relief of
ear pain, may then have purulent otorrhea)
• Dysequilibrium (not common)
• Conductive hearing loss (usually transient)
• High fever, severe pain behind ear, facial paralysis (unusual complications)
DDx Otitis Media - answers• Otitis externa
o More painful, normal-appearing ear drum
• Eustachian tube dysfunction
o Check if recurrent unilateral AOM (>2 over 6 months). Do fiberoptic
nasopharyngoscopy and/or contrast MRI of skull base to rule out malignant process
• Herpes zoster infection
o Development of dermatomal vesicular rash that evolves into crusted lesions. Pain
may precede rash. Ramsay Hunt syndrome presents with triad of ipsilateral facial
paralysis, ear pain, and vesicles involving auditory canal and auricle. Can cause vertigo
Lab/diagnostics Otitis Media - answers• Common organism: strep pneumoniae, H.
influenza. Group A beta-hemolytic strep, staph aureus, M. catarrhalis less frequently
• Otoscopic exam (standard)
o Redness, opacification, bulging TM
o Otitis media with effusion: TM cloudy, yellowish or opaque when fluid in middle ear
• Pneumatoscopy (allows eval of tympanic membrane motion)
• Weber (demonstrates conductive hearing loss)
o Perceived louder in infected ear (common)
o If sensorineural loss, sound may lateralize in noninfected ear (rare)
Txt Plan Otitis Media - answers• Amoxicillin: 500 mg Q12 hours or 250 mg Q 8 hours 10
days...if severe: 875 mg Q12 hours or 500 mg TID 5-7 days
• Augmentin (if amoxicillin fails. Tx for another 10 days)
, • PCN allergy:
o Cefdinir (3rd gen cephalosporin): 300 mg BID or 600 mg once daily
o Cefpodoxime 200 mg BIC
o Cefuroxime (2nd gen): 500 mg Q12 hours
o Ceftriaxone (3rd gen): 2 g IM or IV once
• Severe allergy to beta-lactam:
o Macrolide: erythromycin, azithromycin, clarithromycin
F/U Otitis Media - answers• Should start to improve within 48 to 72 hours - if no
improvement should be re-examined
Edu Otitis Media - answers• If TM ruptures, it will heal in most cases. Tx with oral and
topical abx (ofloxacin)
• Most effusions will resolve over 12 weeks - use oral decongestants
Viral Conjunctivitis - answerso Viral:
Injection, watery discharge during the day, scant, stringy that is mucus rather than pus.
Burning, sandy, or gritty feelin gin one eye. Morning crusting with scant mucus
throughout the day. Second eye usually becomes involved within 24-48 hours
Usually gets worse for the 1st 3-5 days, with gradual resolution over the following 1 or 2
weeks for total course of 2-3 weeks.
Chlamydial Conjunctivitis - answerso Chlamydial
Unilateral, sometimes bilateral, follicular conjunctivitis. Weeks to months, does not
respond to topical abx therapy. Can be associated keratitis
Dx confirmed with Giemsa or direct fluorescent antibody staining or conjuctival smears,
culture, or PCR of swabbed specimens
Bacterial Conjunctivitis - answerso Bacterial:
Organisms: Staph aureus, strep pneumoniae, H influenza, M catarrhalis
Redness and discharge in 1 eye, but can be bilateral. "stuck shut" in morning. Purulent
discharge, thick and globular, yellow, white, or green
Noninfectious Conjunctivitis - answers• Noninfectious
o Allergic:
Bilateral redness, watery discharge, and itching
o Nonallergic:
Conjunctivitis Lab/diagnostics: - answersLab/diagnostics:
• Not normally necessary. They now have rapid test for adenoviral conjunctivitis
Conjunctivitis Tx plan: - answersRESOURCES
Conjunctivitis f/u - answersRESOURCES
Conjunctivitis education - answersRESOURCES
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